Parents with New Partners

First Name *

Last Name *

Email *

Phone *

Address

City

State

Postal code

Is there someone that you would prefer NOT attend the same class as you are attending? *

Yes

If YES, please provide the name of the person that you would not want to attend the same class. Please note that if someone has named you as a person with whom they do not attend with, the person who registered first will be given priority. If NO, please skip and go to Select Date.

Select Date

Saturday, October 19th

Thursday, December 12th

Click on the field below to select the class date.

Parent with New Partners Class Date *

At this time the program is offered ONLY online. Please check all that apply:

I would prefer to participate in person.

I would prefer to participate online using zoom.

I have no preference.

If you would like to bring a guest with you, please provide your guest's contact information.

Guest First Name

Guest Last Name

Guest Email

Guest Phone #

Captcha

Fee is $125.00

$225 for participant with guest

Payment *

$ 125

$ 225

Other amount